[Medical professionalism: historical and religious aspects]. / Profesionalismo médico: aspectos históricos y religiosos.

The essence of the medical profession resides in the medical act, whereupon a sick human being meets another with the power to heal him or her. The source of this power has evolved from the divinity itself through magic to science or acquired knowledge. This power implies acknowledgement of values that are inherent to the profession as well as responsibility toward one's own conscience and toward society, elements considered constitutive of what we now call professionalism. From antiquity these principles have evolved into behavioral codes containing variable components according to the different ages and cultures, but also permenent core values such as respect for life, altruism, and honesty, among others. Scientific and technological advances have magnified medical power but at the same time they have required that the philosophical and ethical principles that ought to inform professional practice be made explicit. This happens at a time when certitudes are questioned or abandoned, relativism and secularism pervade culture, and traditional medical values are challenged. Therefore, consensus attainment appears for some as the only legitimation of the ethics of professional medical acts, while for others the ancestral principles and values of medicine have permanent validity as objective goods based on the dignity of the human person.

Prevención de osteoporosis / Osteoporosis prevention

Un alto número de personas, especialmente mujeres, presenta osteoporosis densitomética, la cual es un importante factor de riesgo para fracturas. La osteoporosis se diagnostica y cuantifica por medio de la densitometría de doble fotón. No todos los pacientes tienen indicación de hacerse una densitometría, sino aquéllos con factores de riesgo o por edad.Para prevenir la osteoporosis es preciso asegurar una buena ingesta de calcio y vitamina D, modificar el estilo de vida y aumentar el ejercicio físico. La terapia farmacológica tiene su principal indicación en el tratamiento de la osteoporosis, aunque puede usarse también preventivamente en pacientes seleccionados por factores de riesgo

A large number of people, especially women, have densitometric osteoporosis, an important risk factor for fractures. Osteoporosis can be diagnosed and measured by double photon densitometry. Not all patients need a bone densitometry, but those with risk factors for osteoporosis or advanced age do. To prevent osteoporosis it is necessary to ensure an adequate calcium and vitamin D intake, to modify lifestyles, and to increase physical exercise. Pharmacologic therapy is mainly prescribed to treat osteoporosis, but it can also be used to prevent it in selected patients with increased risk factors

Profesionalismo médico: aspectos históricos y religiosos / Medical professionalism: Historical and religious aspects

The essence of the medical profession resides in the medical act, whereupon a sick human being meets another with the power to heal him or her. The source of this power has evolved from the divinity itself through magic to science or acquired knowledge. This power implies acknowledgement of values that are inherent to the profession as well as responsibility toward one's own conscience and toward society, elements considered constitutive of what we now call professionalism. From antiquity these principles have evolved into behavioral codes containing variable components according to the different ages and cultures, but also permenent core values such as respect for life, altruism, and honesty, among others. Scientific and technological advances have magnified medical power but at the same time they have required that the philosophical and ethical principles that ought to inform professional practice be made explicit. This happens at a time when certitudes are questioned or abandoned, relativism and secularism pervade culture, and traditional medical values are challenged. Therefore, consensus attainment appears for some as the only legitimation of the ethics of professional medical acts, while for others the ancestral principles and values of medicine have permanent validity as objective goods based on the dignity of the human person.

Características de presentación del microcarcinoma papilar del tiroides. Experiencia retrospectiva de los últimos 12 años / Pathological characteristics of thyroid microcarcinoma. A review of 402 biopsies

Background: Thyroid microcarcinoma is a tumor of 10 mm or less, that should have a low risk of mortality. However, a subgroup of these carcinomas is as aggressive as bigger tumors. Aim: To describe the pathological presentation of these tumors, and compare them with larger tumors. Material and methods: All pathological samples of thyroid carcinoma that were obtained between 1992 and 2003, were studied. In all biopsies, the pathological type, tumor size, the focal or multifocal character, the presence of lymph node involvement and the presence of lymphocytic thyroiditis or thyroid hyperplasia, were recorded. Results: One hundred eighteen microcarcinomas and 284 larger tumors were studied. The mean age of patients with microcarcinoma and larger tumors was 42.7±14 and 49.3±16 years respectively (p <0,001) and 83% were female, without gender differences between tumor types. Mean size of microcarcinomas was 8.6 mm and 116 (98%) were papillary carcinomas. Of these, 109 (94%) were well differentiated and seven (6%) were moderately differentiated. Thirty six (31%) were multifocal and in 10 (8,6%), there was lymph node involvement. The mean size of larger tumors was 23.8 mm and 241 (85%) were papillary carcinomas. Of these, 200 (83%) were well differentiated, and 41 (17%) were moderately differentiated. Eighty five (35%) were multifocal and in 44 (18%) there was lymph node involvement. The prevalence of thyroiditis and hyperplasia was significantly higher among microcarcinomas than in larger tumors (15 and 2.5%, respectively, p <0.001, for the former; 32.4 and 1.7%, respectively, p <0.001, for the latter). Conclusions: In this series, one third of microcarcinomas were multifocal and 10% had lymph node involvement. Therefore, the aggressiveness of these tumors is higher than what is reported in the literature and they should be treated with total thyroidectomy.

Ingesta de calcio y densidad ósea mineral en la menopausia: datos de una muestra de mujeres chilenas seguidas durante cinco años con suplementación cálcica / Relationship between calcium intake and bone mineral density in menopausal women followed for five years with calcium supplementation

Background: A low calcium intake is considered a risk factor for osteoporosis. Aim: To measure calcium intake and its relationship to bone mineral density in postmenopausal women and to assess the long term changes in bone mineral density after calcium supplementation. Patients and methods: in 80 postmenopausal women older than 41 years of age, calcium intake was assessed using dietary inquires and bone mineral density was measured using a double beam radiological densitometer. Twenty-four ramdomly selected women received a daily calcium supplementation of 500 mg during five years and their bone mineral density was measured at 1,3 and 5 years. Results: Initial calcium intake was 745±37mg/day, and it did not change in the 5 years follow up. There was no relationship between bone mineral density and calcium intake. In supplemented women, bone density did not change significantly at year one. At year three, a significant reduction was observed in the spine (-4.2 percent), Wards triangle (-4 percent) and whole body mineral content(-1.14 percent). At year five, there was a significant increase in bone density at the spine femoral neck and Wards triangle as compared with year three, but not with baseline measurements. No significant differences after supplementation were observed between women with initial calcium intake of less than 500 mg/day or over this value. Conclusions: Calcium intake in urban Chilean postmenopausal women is below recommendations and stable over time. Calcium intake and bone mineral density after the meinopause are not correlated. A 500 mg/day calcium supplementation during 5 years is associated with a late reversal of the postmenopausal bone-losing trend

Síndrome de Cushing: problemas de diagnóstico y tratamiento en 27 casos / Cushing syndrome: diagnosis and treatment in 27 patients

Problems of diagnosis and treatment were analyzed in 27 patients with Cushing syndrome (25 confirmed by anatomic findings) followed for a mean fo 50 months. The etiology was Cushing disease in 14 (52%), suprarenal tumor in 9 (33%) and ectopic secretion of ACTH in 4(15%). Determination of plasma cortisol levels at 4PM or 11 PM was a highly sensitive test for the presence of this syndrome (100%). High resolution computed tomography was considerably more effective than conventional X ray studies of the sella in patients with Cushing disease (42 vs 20%. Treatment has been totally effective in all patients with bening suprarenal lesions. Cure was obtrained in 64% of patients with pituitary lesions and 0% of patients with Cushing syndrome associated to malignancy

Síndrome de ovario poliquístico como expresión de déficit de la enzima 3ß hidroxiesteroide deshidrogenasa / Polycystic ovary syndrome as expression of 3-beta-hydroxysteroid dehydrogenase deficit

Los defectos enzimáticos de expresión tardía de la esteroidogénesis suprarrenal están entre las causas más comunes de hirsutismo. Esta forma de hiperandrogenismo puede asumir las características clínicas de un síndrome de ovario poliquístico, lo que viene a confirmar la multicausalidad de esta última condición. Se comunica el caso de una mujer de 18 años con amenorrea secundaria e hirsutismo, cuya concentración sérica de testosterona y de DHEA-S eran 175 ng/dl y 7,3 *g/ml respectivamente y la relación LH/FSH de 5,9. La administración de dexametasona produjo una marcada reducción en la concentración de testosterona y DHEA-S, en tanto que el estímulo con ACTH se asoció a un aumento de 17 hidroxipregnenolona y de la relación 17 hidroxipregnenolona/17 hidroxiprogesterona en el rango descrito para el déficit de 3ß hidroxiesteroide deshidrogenasa